Ceruso Massimo, Taddei Fulvia, Bigazzi Prospero, Manfrini Marco
Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
Injury. 2008 Sep;39 Suppl 3:S68-74. doi: 10.1016/j.injury.2008.05.014. Epub 2008 Aug 15.
Vascularised fibula transfer (VFT) is a trustworthy procedure in the reconstruction of skeletal defects secondary to several pathological conditions. Over the last 20 years, progress in diagnosis in skeletal oncology and in adjuvant therapy has increased the possibility of applying limb-saving procedures in the treatment of bone sarcoma. In this context, VFT appeared to be a valuable reconstructive tool following the wide segmental resection of the long bones of the limbs. The vascularized fibula allows for fast bone fusion. It also demonstrates a tendency of progressive hypertrophy and, in those instances in which it is associated with an avascular massive bone allograft (MBA), it induces a process of osteo-integration which enhances the biomechanical properties of a combined graft. In order to assess the progression of the morphologic and structural changes of combined bone grafts we reviewed a group of 31 bone sarcoma patients who had had tibia reconstruction with a VFT inlaid in a massive allograft. Patients had been operated on between 1994 and 2006. Ages ranged from 4 to 31 years (mean 14 years). Thirty patients had received neo-adjuvant chemotherapy. Morphological variations were investigated by means of serial X-ray and CT scan examinations. All patients were regularly reviewed over an average time of 75 months (range 14-154 months). Computer assisted analysis was repeated at every control and performed at the same levels within the reconstruction, so that subsequent CT exams could be compared. We measured the sagittal and transverse diameters, total and medullary area, cortical thickness and cortical density of the VFT. Cortical thickness and cortical density of the massive bone allograft were measured as well. Two different remodelling patterns of the combined graft could be noted over time, that depended on the load trend on the vascularised fibula and that varied according to the persisting integrity of the allograft shell.
带血管蒂腓骨转移术（VFT）是用于重建多种病理状况继发的骨骼缺损的可靠手术。在过去20年中，骨骼肿瘤诊断及辅助治疗方面的进展增加了在骨肉瘤治疗中应用保肢手术的可能性。在此背景下，VFT在四肢长骨广泛节段切除术后似乎成为一种有价值的重建工具。带血管蒂的腓骨可实现快速骨融合。它还表现出渐进性肥大的趋势，并且在与无血管大块骨移植（MBA）联合应用的情况下，会引发骨整合过程，从而增强复合移植骨的生物力学性能。为了评估复合骨移植形态和结构变化的进展情况，我们回顾了一组31例骨肉瘤患者，这些患者接受了带血管蒂腓骨嵌入大块同种异体骨的胫骨重建手术。患者手术时间在1994年至2006年之间。年龄范围为4至31岁（平均14岁）。30例患者接受了新辅助化疗。通过系列X线和CT扫描检查来研究形态学变化。所有患者平均随访75个月（范围14 - 154个月）。每次复查时都重复进行计算机辅助分析，并在重建部位的相同层面进行，以便能够比较后续的CT检查结果。我们测量了带血管蒂腓骨的矢状径和横径、总面积和髓腔面积、皮质厚度和皮质密度。还测量了大块骨移植的皮质厚度和皮质密度。随着时间推移，可以观察到复合移植骨有两种不同的重塑模式，这取决于带血管蒂腓骨上的负荷趋势，并且根据同种异体骨壳的持续完整性而有所不同。
